Enfermedad de Castleman unicéntrica, una causa infrecuente de masa cervical

La enfermedad de Castleman (EC) describe una serie de desórdenes linfoproliferativos de patrones histológicos similares, pero de etiologías, presentaciones clínicas y enfrentamientos notoriamente variables. Se presenta el caso de un paciente que consultó por masa cervical, cuyo estudio final concluyó EC unicéntrica, la cual se resolvió de forma quirúrgica. Además, se presenta una revisión actualizada del tema, con foco en la enfermedad unicéntrica.

Castleman's disease (CD) describes several lymphoproliferative disorders with similar histological patterns, but with notoriously variable etiologies, clinical presentations, and management. We present the case of a patient who consulted with cervical mass, whose final study concluded with unicentric CD, which was treated surgically. In addition, an updated review of the subject is presented, focusing on unicentric disease.

Lipoma Cervicofacial Gigante: Reporte de un caso / Giant Cervicofacial Lipoma: A Case Report

RESUMEN: Los lipomas son neoplasias benignas formadas por tejido adiposo maduro y que representan los tumores mesenquimales más frecuentes. Los lipomas gigantes se definen en relación a un tamaño mayor de 10 centímetros o un peso mayor a 1 kilogramo. Su presentación a nivel de cabeza y el cuello es infrecuente. Se caracterizan por tener un crecimiento lento, progresivo, deformante y asintomático. Es necesaria la realización de pruebas de imagen para su correcta localización anatómica y establecer relaciones con las estructuras vecinas. El tratamiento de elección es la escisión quirúrgica de la masa. La planificación pre-quirúrgica en este tipo de casos debe ser minuciosa para garantizar la conservación tanto de la función como de la estética cervicofacial. Se reporta el caso de una mujer de 50 años que presenta una tumoración gigante cervicofacial de 9 años de evolución, diagnosticada como lipoma, con sus características clínicas, imageneológicas, histopatológicas y su manejo terapéutico.

ABSTRACT: Lipomas are benign neoplasms formed by mature adipose tissue and represent the most frequent mesenchymal tumors. Giant lipomas are defined in relation to a size greater than 10 centimeters or a weight greater than 1 kilogram. Their presentation at head and neck level is infrequent. They are characterized by having a slow, progressive, deforming and asymptomatic growth. Imaging tests are necessary for their correct anatomical location and the establishment of relationships with neighboring structures. The treatment of choice is surgical excision of the mass. Pre-surgical planning in this type of case must be meticulous to guarantee the preservation of both function and cervicofacial aesthetics. The case of a 50-year-old woman with a giant cervicofacial tumor of 9 years of evolution, diagnosed as lipoma, with its clinical, imaging, histopathological characteristics, and therapeutic management is reported.

Malformaciones vasculares linfáticas de cabeza y cuello en pacientes pediátricos: revisión de la literatura

Resumen Los linfangiomas son malformaciones vasculares linfáticas de etiología no completamente precisada, que se manifiestan principalmente en edad pediátrica. Su localización más frecuente es en cabeza y cuello, donde pueden potencialmente generar compromiso de vía aérea. En el diagnóstico, la sospecha clínica juega un rol fundamental y debe ser considerado dentro del diagnóstico diferencial de masa cervical. Para el estudio resulta útil la ecografía como enfrentamiento inicial, y la resonancia magnética debiese ser de elección en estos casos. Actualmente, también es posible contar con diagnóstico antenatal debido a los avances imagenológicos en obstetricia. El manejo es controvertido y no existen protocolos terapéuticos mundialmente validados. Las opciones terapéuticas incluyen el manejo quirúrgico, la administración de agentes esclerosantes, terapia sistémica o una combinación de éstos. Debido a sus potenciales implicancias estéticas y funcionales en el área de cabeza y cuello, el otorrinolaringólogo debe estar familiarizado con esta patología, motivo por el cual presentamos este artículo de revisión.

Abstract Lymphangiomas are lymphatic vascular malformations of unclear etiology that generally manifest in pedriatic-age patients. The most frequent localization is in the head and neck, where they can potentially generate airway compromise. Clinical suspicion plays a fundamental role in its diagnosis, and should be considered in the differential diagnosis of pediatric head and neck masses. Imaginologic investigations include the use of ultrasound as an initial approach, with magnetic resonance imaging being the modality of choice. Currently, it is also possible to establish an antenatal diagnosis due to imaging advances in obstetrics. Treatment is challenging and there is still not a protocol that is universally accepted. Op- tions include surgery, sclerotherapy, systemic agents, or a combination of the above. Due to its potential esthetic and functional implications in the head and neck region, the otolaryn- gologist must be aware of this pathology, reason for which we present this review.

Neuroblastoma cervical: presentación de casos y revisión actualizada del tema / Cervical neuroblastoma: presentation of cases and updated review of the topic

El neuroblastoma es uno de los tumores sólidos extracraneales más comunes en la edad pediátrica, y se origina en células precursoras del sistema nervioso simpático. La ubicación cervical corresponde a un 2-5% del total de los neuroblastomas y puede tener distintas manifestaciones clínicas, tales como masa cervical, disnea, estridor, síndrome de Horner o disfagia. Esta entidad debe ser considerada dentro del diagnóstico diferencial de una masa cervical pediátrica, especialmente ante la presencia de masas sólidas, laterales o paramedianas, palpables o no al examen físico. El tratamiento específico del neuroblastoma depende de la clasificación de riesgo del paciente, pudiendo ser expectante en casos específicos, exclusivamente quirúrgico, o bien requerir complementarse con otras terapias. En este artículo se presentan 2 casos clínicos de pacientes pediátricos con neuroblastoma cervical tratados de forma exclusiva y exitosa con cirugía, y una revisión del tema.

Neuroblastoma is one of the commonest extracranial solid tumors at pediatric age, originating from sympathetic nervous system precursor cells. Cervical position stands for 2-5% of all neuroblastomas, with variable clinical expression that includes cervical mass, dyspnea, stridor, Horner syndrome and dysphagia. This condition must be considered in the differential diagnosis of a pediatric cervical mass, specially in those solid, lateral/paramedian masses that could be palpable or not at physical examination. The specific treatment in neuroblastoma depends on patient´s risk group, including conservative follow-up in selected cases, surgery alone, or complementary perioperative therapy with chemotherapy and others. In this article, the group report two cases of cervical neuroblastoma exclusively treated with surgery with good results, and a literature review.

Timo cervical aberrante: masa cervical pediátrica inusual, revisión bibliográfica y reporte de caso / Aberrant cervical thymus: unusual type of pediatric cervical mass, bibliographic review and case report

Las masas cervicales representan un desafío habitual en pediatría, que en su mayoría son de etiología benigna. Una de las causas menos conocidas es el timo cervical aberrante, una entidad clínica resultante de anormalidades en el descenso del timo a lo largo de su ruta habitual (tracto timo-faríngeo). Este es un cuadro frecuentemente mal diagnosticado, del que se desconoce su incidencia real. Actualmente, su incidencia relativa parece ir en aumento en conjunto con la disponibilidad de la ecotomografía. En Chile no hay registro epidemiológico de este cuadro ni existen reportes de caso documentados. En este artículo se presenta una revisión bibliográfica sobre masa cervical pediátrica y un reporte de caso de un paciente chileno.

Cervical masses constitute a frequent challenge in pediatric care, mostly which are of benign nature. One of the lesser known causes is the aberrant cervical thymus, which results from embryological abnormalities during the thymus descent through its normal route (thymo-pharyngeal duct). This is a frequently misdiagnosed syndrome, for which its real incidence remains unknown. Nowadays, its relative incidence is on the rise along with ultrasound availability. There is no epidemiological record or documented case reports of this entity in Chile. In this article we present a bibliographic revision on cervical mass and a case report from a Chilean patient.

Quiste de primer arco branquial, reporte de caso y revisión de la literatura / First branchial arch cyst, case report and review of the literature

Los quistes branquiales de primer arco son una malformación congénita de baja frecuencia. Se desarrollan por la fusión incompleta de la hendidura faríngea entre el primer y el segundo arco branquial. Pueden permanecer silentes por mucho tiempo y manifestarse cuando se sobreinfectan, causando significativa morbilidad. Por lo general, se presentan en la infancia, pero muchas veces su diagnóstico es tardío ya que son difíciles de diferenciar de adenopatías u otras masas, debiendo ser considerados dentro del diagnóstico diferencial de masa cervical y parotídea, especialmente en pacientes jóvenes. La cirugía es el tratamiento definitivo, requiriendo una escisión completa del quiste y su trayecto fistuloso para evitar las recurrencias. Debido a su localización intra-parotídea y complejidad morfológica, es necesario conocer la anatomía en detalle para evitar lesionar el nervio facial. En esta revisión, se pretende presentar las características clínicas y resultados quirúrgicos en una paciente lactante con diagnóstico de quiste de primer arco, asícomo efectuar una revisión de la literatura.

First branchial arch cysts are very infrequent congenital malformations. Their development is due to an incomplete fusion of the pharyngeal cleft between the first and second branchial arch. They can remain silent for a very long time and manifest when they become infected, causing significant morbidity. In general, they present in child-hood, but many times its diagnosis occurs on a late onset since they are difficult to differentiate from lymphadenopathies or other masses. So, they should be considered on the differential diagnosis of cervical and parotid masses, especially in young patients. Surgery is its definitive treatment. Complete excision of the cyst and its fistula must be performed to avoid recurrences. Due to its intraparotid localization and morphological complexity it is necessary to understand the anatomy in detail to avoid facial nerve le-sions. In this revision, we aim to present clinical characteristics and surgical outcomes in an infant with the diagnosis of first branchial arch cyst and to review the literature.

Vía aérea difícil, caso clínico / Difficult airway: clinical case

Introducción: la American Society of Anesthesiologists definió la vía aérea difícil como la situación clínica en la que un anestesiólogo con entrenamiento convencional experimenta dificultad para ventilar con máscara facial, dificultad para la intubación endotraqueal o ambas. Ventilación difícil con máscara es 1) la imposibilidad para un anestesiólogo que no cuenta con ayuda, de mantener la saturación de oxígeno (SpO2) > 90% al administrar oxígeno al 100% y ventilar con presión positiva mediante máscara facial a un paciente cuya SpO2 era del 90% antes de la intervención anestésica o 2) la imposibilidad para un anestesiólogo que no cuenta con ayuda, de evitar o revertir los signos de ventilación inadecuada durante la ventilación con presión positiva mediante máscara facial. Estos signos incluyen: cianosis, ausencia de movimientos del tórax, signos auscultatorios de obstrucción severa de la vía aérea, distensión gástrica por entrada de gas y cambios hemodinámicos secundarios a hipoxemia e hipercapnia. Laringoscopia difícil: imposibilidad para visualizar alguna parte de la glotis durante la laringoscopia convencional. Intubación difícil: situación en la que se requieren más de tres intentos o más de diez minutos para la inserción adecuada del tubo endotraqueal mediante laringoscopia convencional. Materiales y métodos: es una revisión de caso clínico y revisión bibliográfica. Resultados: el presente caso ilustra una de las situaciones de vía aérea difícil prevista producidas por patología de vía aérea y mediastino anterior como son las masas tiroideas. Presentación poco frecuente y que implica un manejo anestésico complejo. Conclusiones: podemos concluir que el manejo de una vía aérea difícil anticipada o no es un reto para el anestesiólogo y requiere el entrenamiento y actualización constante del mismo.

Introduction: the ASA define difficult airway as the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation, endotracheal intubation difficulty , or both. Difficult mask ventilation is 1) the impossibility for an anesthesiologist who has no help to maintain oxygen saturation (SpO2) > 90 % when using 100% oxygen and positive pressure ventilation by face mask to a patient whose SpO2 was 90 % before anesthetic intervention or 2) the impossibility for an anesthesiologist who has no help prevent or reverse signs of inadequate ventilation during positive pressure ventilation by face mask . These signs include cyanosis, absence of chest movement, auscultation signs of severe airway obstruction, gastric distension by gas inlet and hypoxemia and hypercapnia secondary to hemodynamic changes. Difficult laryngoscopy: unable to display some part of the glottis during conventional laryngoscopy. Difficult intubation: a situation in which more than three attempts or more than ten minutes for the proper insertion of the endotracheal tube with conventional laryngoscopy is required.1 Materials and methods: this is a clinical case review and a literature review. Results: this case illustrates one of the difficult airway situations envisaged produced by airway pathology and anterior mediastinal masses such as thyroid. Rare presentation and involves a complex anesthetic management. Conclusions: we can conclude that the difficult airway management anticipated or not, is a challenge for the anesthesiologist and requires constant training and update.

Neuroblastoma congénito cervical en recién nacido: presentación de un caso / Cervical congenital neuroblastome in a newborn: presentation of a case

Los neuroblastomas congénitos cervicales son muy raros. Esta forma de cáncer infantil se forma en el tejido nervioso y por lo general suele presentarse con mayor frecuencia en las glándulas suprarrenales. Aunque puede aparecer prenatalmente, es más frecuente que se diagnostique en el primer año de vida. Son tumores agresivos con una alta mortalidad. En casi todos los casos (50-60 por ciento de los mismos), para cuando se detecta un neuroblastoma, ya se ha diseminado a otras partes del cuerpo. Se presenta un caso de recién nacido que las primeras 24 horas, muestra una historia de compromiso de vías respiratorias y digestivas asociado a una masa cervical sólida y parálisis de XII par craneal.

Cervical congenital neuroblastomes are very rare. This form of infantile cancer forms in the nervous tissue and generally it uses to appear more frequently in the suprarenal glands. Although they may appear prenatally, they are more frequent in the first year after birth. They are aggressive tumors with a high mortality. In almost all the cases (50/60 percent of them), when a neuroblastome is detected, it is already disseminated to other parts of the body. We present the case of a newborn who shows a history of respiratory and digestive tracts compromise associated to a solid cervical mass and XII cranial par paralysis during the first 24 hours after birth.

Citodiagnóstico en otorrinolaringología: diez años de experiencia en el Hospital Barros Luco Trudeau 2001 a 2010 / Citodiagnostic in otorhinolaryngology: ten years of experience in Barros Luco Hospital 2001 to 2010

Introducción: Dentro del estudio diagnóstico de pacientes con masa cervical la punción por aspiración con aguja fina (PAAF) es una herramienta útil debido a su facilidad y seguridad. Objetivo: Evaluar el rendimiento de las PAAF realizadas en nuestro servicio en los últimos diez años. Material y método: Estudio retrospectivo y descriptivo. Se obtuvieron los datos de pacientes sometidos a PAAF en el Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau entre los años 2001 a 2010 y se correlacionaron con las biopsias definitivas atingentes. Resultados: Se realizaron 197 PAAF, de las cuales 140 (71%) fueron aptas para estudio citológico y 77 tenían biopsias concomitantes. Se obtuvo una sensibilidad de 46°%, especificidad de 85°%, valor predictivo positivo de 74°% y valorpredictivo negativo de 62°%. La localización para la cual se obtuvo un mejor rendimiento de la técnica fue para glándulas salivales y los diagnósticos con mejor rendimiento fueron carcinoma escamoso y tumor mixto. Discusión: La PAAFes una herramienta subutilizada. Obtuvimos una alta tasa de muestras insuficientes para estudio diagnóstico y, en nuestro medio, es útil para descartar neo-plasia maligna en masas de glándulas salivales y metástasis de carcinoma escamoso.

Introduction: Fine needle aspiration (FNA) is an useful tool for the diagnostic evaluation of patients with a cervical mass, because of its feasibility and safety. Aim: To determine the accuracy of FNA cytology in our hospital over the last ten years. Material and method: A retrospective and descriptive study. Data were obtained from patients undergoing FNA in the Department of Otolaryngology, Hospital Barros Luco Trudeau from 2001 to 2010 and compared with the corresponding histology report of the original surgical specimen. Results: A total of 197 FNA procedures were performed in 143 patients. A definite cytological diagnosis was made in 140 patients (71%%). 77 patients had corresponding histology samples. The sensitivity was 46%%, specificity 85%%, positive predictive value 74% and negative predictive value 62%. The location for which we obtained a better performance of the technique was in salivary glands and the best performing diagnosis was squamous cell carcinoma. Discussion: FNA is an underused diagnostic tool with a high rate of non diagnostic samples. It is useful to rule out malignancy in salivary gland masses and metastatic squamous cell carcinoma in lymph nodes.

Exit: tratamiento exútero intraparto: reporte de caso y revisión de la literatura / Exit: ex-utero intrapartum treatment: a case report and literature review

Introducción y objetivo: la técnica Tratamiento exútero intraparto (EXIT) permite el aseguramiento de la vía aérea fetal mientras se mantiene el soporte uteroplacentario íntegro. El objetivo de reportar este caso es describir el procedimiento y hacer una revisión de la literatura mundial respecto a consideraciones anestésicas y complicaciones asociadas. Materiales y métodos: presentamos el caso de una neonato femenina de 39 semanas de gestación que nace mediante la técnica Tratamiento exútero intraparto (EXIT) debido a una potencial obstrucción de la vía aérea detectada en una ecografía de tercer trimestre. Se realizó una búsqueda sistemática usando las palabras clave: Tratamiento exútero intraparto (EXIT), masas cervicales congénitas y CHAOS en las bases de datos Medline via Pub Med, Ovid, y la base latinoamericana SciELO. Resultados: se encontraron un total de 183 artículos, de los cuales 76 estaban relacionados directamente con el tema, de estos se seleccionaron 8 reportes de caso, 2 series de casos y 14 revisiones del tema. Conclusiones: la estrategia EXIT prueba ser una herramienta útil en el adecuado manejo de los neo-natos con obstrucciones congénitas de la vía aérea.

Introduction and objective: The EXIT procedure (ex-utero intrapartum treatment) is aimed at securing the fetal high airway whilst maintaining integral uteroplacentary circulation. The purpose of reporting this case was to describe the procedure and review the worldwide literature regarding anesthetic considerations and associated complications. Materials and methods: The case of a 39-week gestation female neonate is presented; she was born at the Clínica del Country (a private highlevel healthcare general hospital located in Bogota, Colombia) by the ex-utero intrapartum treatment (EXIT) technique due to a potential obstruction of the airway detected during third-trimester echography. A systematic search was made of Medline databases via PubMed, Ovid, and the SciELO Latin-American database using the following key words: EXIT, ex-utero intrapartum treatment, congenital cervical mass, CHAOS. Results: 183 articles were found, of which 76 were directly related to the topic; 8 case reports, 2 case series and 14 reviews of the topic were selected. Conclusion: The EXIT strategy has proved to be a useful tool in the suitable management of neonates suffering congenital obstruction of the airway.

Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor in an Adolscence, Manifested as Isolated Cervical Mass / 임상소아혈액종양

Ewing sarcoma/peripheral primitive neuroectodermal tumor (ES/PPNET) arises from bone or soft tissue of many sites of body, but ES/PPNET, as primary lesion, in the soft tissue of neck is very uncommon. The authors experienced a case of ES/PPNET in a 17-year-old girl, which was manifested as isolated cervical mass in the soft tissue without any other suspected primary lesion or metastasis. We report the case with a brief review of the literature.

Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor in an Adolscence, Manifested as Isolated Cervical Mass / 임상소아혈액종양

Ewing sarcoma/peripheral primitive neuroectodermal tumor (ES/PPNET) arises from bone or soft tissue of many sites of body, but ES/PPNET, as primary lesion, in the soft tissue of neck is very uncommon. The authors experienced a case of ES/PPNET in a 17-year-old girl, which was manifested as isolated cervical mass in the soft tissue without any other suspected primary lesion or metastasis. We report the case with a brief review of the literature.

The efficacy of concurrent cisplatin and 5-flurouracil chemotherapy and radiation therapy for locally advanced cancer of the uterine cervix / 부인종양

OBJECTIVE: To evaluate the efficacy of concurrent chemoradiation (CCRT) using 5-flurouracil (5-FU) and cisplatin for locally advanced cervical cancer. METHODS: We reviewed the medical records of 57 patients with locally advanced cervical cancer (stage IIB-IVA and bulky IB2-IIA tumor) who underwent the CCRT at Dong-A University Hospital from January 1997 to June 2007. The CCRT consisted of 5-FU, cisplatin and pelvic radiation. Every three weeks, 75 mg/m(2) cisplatin was administered on the first day of each cycle and 5-FU was infused at the dose of 1,000 mg/m(2)/d from the second day to the fifth day of each cycle. Radiation was administered to the pelvis at a daily dose of 1.8 Gy for five days per week until a medium accumulated dose reached to 50.4 Gy. If necessary, the radiation field was extended to include paraaortic lymph nodes. Consolidation chemotherapy was performed using 5-FU and cisplatin. RESULTS: Fifty-seven patients were enrolled and the median follow-up duration was 53 months (range 7-120 months). The overall response rate was 91.5% (74% complete response and 17.5% partial response). The 5-year overall survival and 3-year progression free survival rates were 69.4% and 74.9%, respectively. During the follow-up period (median 23 months, range 7-60 months), fourteen patients were diagnosed as recurrent disease. CONCLUSION: CCRT with 5-FU and cisplatin which is the primary treatment for patients with locally advanced cervical cancer was effective and well tolerated.

Laringocele: aspecto ultra-sonográfico - relato de caso / External laryngocele: sonographic appearance - a case report

Laringoceles são lesões relativamente raras definidas como dilatações anômalas dos sáculos dos ventrículos laríngeos. A classificação usual divide a laringocele em interna, externa e combinada ou mista. Laringoceles internas são as que se localizam medialmente à cartilagem tireóidea e geralmente causam compressão nas bandas ventriculares levando a rouquidão e sintomas compressivos na via aérea. As externas se estendem através da membrana tireóidea, apresentando-se como massas cervicais, e as mistas são as que ocupam as duas regiões, podendo causar ambos os sintomas. O diagnóstico é geralmente feito por tomografia computadorizada e/ou laringoscopia. Apresentamos um caso de laringocele mista em que o diagnóstico foi sugerido no exame de ultra-sonografia, num paciente encaminhado com história de massa cervical.

Laryngoceles are fairly unusual diseases defined as anomalous saccular dilatation of the laryngeal ventricles. The usual classification divides laryngoceles into internal, external and mixed types. Internal laryngoceles are those located medially to the thyrohyoid membrane and usually compress the false vocal cords causing hoarseness or airway obstructive symptoms. External laryngoceles extend through the thyrohyoid membrane, presenting as cervical masses; and mixed laryngoceles present both the internal and external components with their respective symptoms. Diagnosis is usually defined by computed tomography and/or laryngoscopy. This is a report of a case of mixed laryngocele diagnosed by ultrasonography in a patient referred for investigation with a history of palpable cervical mass.

Ectopic Thyroid Tissue With a Rare Vascular Variation / Tejido Tiroideo Ectópico con una Rara Variación Vascular

Awareness of the variations and anomalous existence of some structures serve as useful guide for both in studies of human anatomy and in clinical practice today. Identification of ectopic thyroid tissue and variations in origin, number and course of the branches of the superior thyroid artery are of significant practical importance for the general, vascular surgeons and radiologist. Angiographic images with such vascular patterns may lead to confusion in interpretation. The relations of these vessels with the other structures are important for accurate diagnostic and invasive techniques and to prevent further complications during surgical interventions. In our routine dissections with the purpose of preparation of the teaching and museum specimens, it was observed that in one of the elderly male cadaver showed median thyroid tissue at a site other than in its usual pretracheal region. It was situated in the median plane extending from the hyoid bone to the front of cricoid cartilage. Normal thyroid gland in the pretracheal region was absent. Added to this rare anomaly a vascular anomaly was found in the same ectopic thyroid tissue. Solely the superior thyroid arteries supplied this median thyroid tissue. The inferior thyroid arteries were found to be absent on both sides supplying this median thyroid tissue.

Conocer la existencia de variaciones y anomalías de algunas estructuras, sirve usualmente como guía para estudios de anatomía humana y práctica clínica. La identificación de tejido tiroideo ectópico y variaciones en origen, número y curso de ramas de la arteria tiroidea superior son, por lo general, de importancia práctica significativa para cirujanos vasculares y radiólogos. Imágenes angiográficas con tales patrones vasculares pueden llevar a confusión en su interpretación. La relación de estos vasos con otras estructuras son importantes en un diagnóstico acucioso, en técnicas invasivas y para prevenir complicaciones durante intervenciones quirúrgicas. En una disección de rutina, con el propósito de preparar piezas anatómicas de museo para la enseñanza, se observó en un cadáver de sexo masculino, tejido tiroideo mediano en un sitio diferente a la región pretraqueal. Estaba situado en el plano mediano extendiéndose desde el hueso hiodes a la parte anterior del cartflago cricoides. La glándula tiroides normal en la región pretraqueal estuvo ausente. Agregada a estainusual variación, una rara anomalía vascular fue encontrada en el mismo tejido tiroideo ectópico, sólo las arterias tiroideas superiores irrigaban este tejido tiroideo mediano. No se encontraron arterias tiroideas inferiores irrigando este tejido.

Miofibromatosis infantil: relato de una enfermedad desesperante / Fibromatosis infantile: report of an aggressive disease

La miofibromatosis es una enfermedad tumoral que afecta casi exclusivamente a lactantes y preescolares. Se caracteriza por múltiples lesiones nodulares compuestas de tejido colágeno y células fusiformes que afectan piel, huesos, tejidos blandos e incluso las vísceras; puede ser solitaria o multicéntrica. Presentamos la evolución clínica de un niño que a los dos años de edad fue llevado por primera vez a consulta por una masa cervical derecha de 4.5 x 6 cm, subcutánea, inmóvil e indolora. Fue intervenido quirúrgicamente en 13 ocasiones; en la última falleció. El caso corresponde al número once reportado con patrón familiar.

This rare entity is characterized by multiple nodular lesions largely composed of collagen-forming spindle cells and involving the subcutis, skeletal muscle, bone and viscera of newborns and infants that occurs in either a solitary or multicentric form. The clinical course of a case is presented. The patient is a 2-year-old male who was brought to our hospital because of a large cervical mass. On physical examination a firm, subcutaneous, immobile painless mass measuring 4.5x6 cm was palpated at right side of neck. After the first admission, 13 complete surgical resections were performed. This patient is the eleventh familial case in the literature. The patient died 10 years after the first surgery.

Differential Diagnosis of Congenital Cervical Masses in Infants and Children / 소아알레르기및호흡기학회지

PURPOSE: Cervical masses are frequently occurred in children. They are most often associated with nonspecific infection. However, they may be presented as congenital abnormalities. Therefore, accurate history taking, physical examination and appropriate diagnostic procedure are absolutely required for the differential diagnosis of neck mass in children. METHODS: To elucidate the clinical characteristics of cervical mass which may help for establishing a correct diagnosis, the clinical records including pathologic findings from the biopsied specimen of twenty-eight children under seventeen years of age who were hospitalized with complain of persistently palpable neck mass were completely reviewed. RESULTS: Pathologic classification of the cervical mass was as follows : 15(53.6%) thyroglossal duct cyst, 7(25.0%) branchial cleft cyst, 5(17.9%) cystic hygroma and 1(3.6%) bronchogenic cyst. Asymptomatic mass was the most common presentation(67.8%). Twenty-six (92.8%) lesions were solitary and 2(7.1%) branchial cleft cyst were multiple. All thyroglossal duct cyst presented as a solitary mass and involved the midline of the neck. Branchial cleft cysts were located around sternocleidomastoid muscle, and multiple branchial cleft cyst located bilaterally in submandibular area. CONCLUSIONS: The accurate medical history, physical examination, and additional pathologic findings are the most important for the diagnosis of congenital neck mass in children.

Masa en cuello por Mycobacterium tuberculosis en un paciente infectado por VIH / A case of a cervical mass due to Mycobacterium tuberculosis in an VIH infected patient

Se presenta el caso de un paciente de sexo masculino con diagnóstico de infección por HIV quien presentó una masa en cuello de 7 x 10 cm, dolorosa, de consistencia dura, adherida, no pulsátil, con edema de la piel adyacente y sin otros signos asociados. La evolución fue de 6 meses. Los estudios de la masa y el esputo dieron como resultado el aislamiento de M. tuberculosis, lo que permitió un adecuado enfoque terapéutico y por consiguiente una respuesta clínica satisfactoria

We report on the case of an HIV-infected male with Mycobacterium tuberculosis infection, manifested as both pulmonary involvement and a cervical mass; lung infection was proven by culture; pathological study of the mass revealed both chronic granulomatous infection and acidfast bacilli. Response to treatment was favorable and rapid. We suggest that every fluid and tissue obtained from HIV-positive patients be routinely stained and cultured for mycobacteria